Dear Dr. Conner,

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Elma Izze Da Silva Magalhães

Academic Editor

PLOS ONE

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3. We note that you have referenced (103). Conner TS, et al. Ultra-processed foods predict poorer mental health in young adults: a cross-sectional investigation in three countries. Unpublished manuscript. University of Otago, New Zealand; 2021.) which has currently not yet been accepted for publication. Please remove this from your References and amend this to state in the body of your manuscript: 103). Conner TS, et al. Ultra-processed foods predict poorer mental health in young adults: a cross-sectional investigation in three countries. Unpublished manuscript. University of Otago, New Zealand; 2021.) as detailed online in our guide for authors

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: The explanation of the dual continuum models is not fully understood in the manner authors writing in the introduction. It is recommended that the authors re write the explanation in a more readable manner in the introduction section.

The authors could relate that Baltic sea diet as fish consumption in the introduction. Most of the readers are not familiar with this diet. Could they explain a little bit more about that diet before writing the results of the study.

The manuscript doesn’t contain the figures of the article.

The data analysis plan was really carefully done. The authors insisted on between subjects analysis and within subject analysis. But I am afraid the mixed model table is a bit hard to relate to that. I am referring to table 4 which is very condensed and full of information. Could the authors write a footnote or more explanation for their mixed model technique. I think the title of the graphs indicate the answer to some of my questions about the results section. I don’t have the graphs in my pdf sent from the journal.

The authors in discussion section reported that the physical activity was the least effective variable for well being based on their analysis and yet they say their results are aligned with others relating more sleep is linked with better mood. If the authors want to report this finding they should get the results section between good sleep quality and mood in the three data sets before jumping to this conclusion.

Reviewer #2: Decision Letter

Dear Authors,

First of all, I congratulate you on your efforts to study such complex interrelationships as those of behavioral and well-being nature. These relationships involve very deep and interconnected mechanisms, which are still not fully understood in all their complexity. The article addresses topics that, although widely studied separately, still lack this integrated and multifaceted perspective to provide a better understanding. I recognize the value of this work for studying different databases, with extensive analyses and not-so-simple interpretations, but I have some comments and suggestions for improving the presentation of these findings.

Title:

The title is somewhat sensationalist regarding the phrase "From surviving to thriving." I think it could perfectly well be just "How sleep, physical activity, and diet shape well-being in young adults." This is merely a suggestion, not an imposition, but I consider that "From surviving to thriving" feels disconnected from the article as a whole, as this statement is never revisited in the text, and the authors did not discuss in the discussion how well-being could be regained or improved based on the observed results. To include this element in the title, it would have been necessary to address how these lifestyle habits are basic human needs and how improving these factors can positively impact individuals' well-being, taking them from basic needs (surviving) to truly living well (thriving).

Abstract

It is appropriate and well summarizes the main points of the study.

Introduction

The introduction, although providing a good contextualization of the studied topic and good justifications for the study's objective, is unnecessarily lengthy. With so much information, the introduction feels long, almost giving the impression that much is already known about the subject, somewhat diminishing the need for another study on this topic. I suggest reducing the text a bit, removing some details about other studies, and leaving this type of comparison between previous studies more for the discussion.

The section of the introduction that talks about the objectives should conclude the introduction; there is no need to start detailing the datasets in the introduction, as this fits better in the methods section.

The paragraph starting at line 158 also seems somewhat unnecessary, as it tries to justify something already justified earlier about the importance of the "big three behaviors." I understand that this information strengthens the rationale for the choice of adjustment variables, but it does not need to be discussed so early in the article.

Methods

The authors do not mention how participants were selected for the original studies. The lack of this information compromises the understanding of possible limitations and biases in the selection process, issues that may affect the representativeness and generalizability of the obtained results. I suggest that the authors briefly mention the type of method used to select participants for each dataset used, and whether participants were selected differently within the same dataset (convenience sample? random sampling?). Some parts of the methods suggest the use of convenience samples, but this needs to be clearer.

It is mentioned that in Study 1, participants who showed evidence of response bias were excluded. What would these response bias evidences used as criteria be? How was this evaluated and judged to decide who would be excluded for this reason?

The eligibility criteria of the original studies also need to be clarified, not just the reasons for exclusion from the analysis.

In line 251, it is mentioned that 818 individuals aged between 17 and 25 years had usable data. This is confusing, as from the beginning (abstract and parts of the introduction), it is stated that participants were between 18 and 15 years old. If one of the datasets included eligible individuals aged 17, then the authors are indeed including individuals aged 17 to 25 in the total N. This needs to be clear from the beginning of the text, preferably from the abstract.

Results

In Table 1, I suggest presenting only the mean and standard deviation of age in each study. I see no reason to present it in categories, especially considering that some ages have very few or no participants, resulting in too much unused information in the table. I also suggest reviewing the rounding of decimal places, as some items do not add up to 100%.

The way SES was assessed was not clear enough in the methods, making it somewhat difficult to understand what these values in Table 1 mean. How was this assessed? What do the mean and standard deviation in the table represent? I suggest explaining this better in the methods section or adding a footnote to facilitate interpretation in the table.

In Table 2, I suggest removing the term "daily" from the title, as Study 1 does not use daily information.

As a general critique of all presented tables, the sample N used in the analyses should always appear, either in the table title, footnote, or within the table itself, as besides the differences in N between studies, it is necessary to be transparent about whether any data remained missing. The article is quite long, and it is difficult to keep searching for this information in other parts of the article to recall.

Another important point: was presenting median and interquartile range considered for variables with skewed distributions? I ask because certainly some of the studied variables have a skewed distribution, and using the mean may not be ideal as it is influenced by extreme values. I suggest evaluating this point.

Discussion

Data from 2021 were used in Study 1. How might the results have been affected by the pandemic context, given that in 2021 the situation was still quite serious, and people had not yet fully resumed their routines and habits, especially regarding the three main behaviors studied? Study 3 also used data collected during a period when COVID-19 was still a major concern. Was this considered? It seems that the results obtained in Study 1, which observed higher consumption of ultra-processed foods, might be related to this data collection period, especially considering the observed correlation between this consumption and depressive symptoms. In many cases, individuals worsened their diet quality during the pandemic due to social isolation, anxiety, and distress during that period. It is possible that many people found some comfort in consuming these unhealthy foods, which might have brought some well-being during this critical period of global health. This needs to be considered in the discussion.

Another important point is that some participants received financial incentives (money or student credit) to participate, which may influence the motivation to participate in the study and its results. This needs to be discussed.

Something else that should be discussed as a limitation, given its implications for the observed results, is the differences in the instruments used for data collection between the studies, as well as the use of self-reported information such as weight and height, which may introduce some inaccuracies and important biases into the data.

Final decision

In light of the comments provided, I recommend that the requested changes and improvements be considered by the authors, and that after the corrections, the article be published.

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Reviewer #1: No

Reviewer #2: No

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From surviving to thriving: How sleep, physical activity, and diet shape well-being in young adults

PONE-D-24-45325R1

Dear Dr. Conner,

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Kind regards,

Elma Izze Da Silva Magalhães

Academic Editor

PLOS ONE